Abstract 4362147: Mitral Annular Calcification Increases Cardiovascular Risk in Patients with Pre-existing Mitral Valve Regurgitation

Background: Mitral annular calcification (MAC) is a chronic inflammatory condition that is associated with future cardiovascular events. There is limited data that explores how MAC impacts outcomes in patients with pre-existing mitral regurgitation (MR). Methods: This is a retrospective analysis using the TriNetX US Collaborative Network database. A database of hospitalized patients ≥50 years was queried using ICD-10 and TriNetX curated codes. We identified those given a discharge diagnosis of MR between 2020-2023, excluding patients with rheumatic mitral valve disease or ESRD. We then stratified by presence/absence of a new diagnosis of MAC (occurring after MR diagnosis). Cohorts were balanced for socio-demographics, body mass index, and common comorbidities including hypertension, hyperlipidemia, diabetes, and tobacco use, with a standard difference of <0.1 considered to indicate adequate balancing. Hazard ratios were calculated for outcomes, with a P<0.05 considered significant. Results: Our query yielded 11,462 patients in the MAC group and 450,474 patients in the no MAC group. Following propensity matching, each group had 11,462 patients. All targeted variables were adequately balanced. Average age was similar in both the MAC and no MAC groups (76 years vs 75.8 years). The populations were majority white (80.3% vs 81.2%) and female (56.8% vs 57.0%). BMI was also similar (29.2 vs 28.7). Among patients with pre-existing MR, subsequently diagnosed MAC was associated with increased 1-year risk of hospitalization (HR 1.22, 95%CI 1.180-1.262, p<0.0001), ICU admission (HR 1.38, 95%CI 1.250-1.524, p<0.0001), ischemic heart disease (HR 1.446, 95%CI 1.289-1.622, p<0.0001), new onset HFpEF (HR 1.286, 95%CI 1.160-1.425, p<0.0001), cerebrovascular disease (HR 1.341, 95%CI 1.190-1.512, p<0.0001), prosthetic valve replacement (HR 2.126, 95%CI 1.786-2.530, p<0.0001), and mitral stenosis (HR 3.16, 95%CI 2.490-5.234, p<0.0001). There was not a significant difference between groups for HFrEF (HR 0.955, p=0.4377), cardiogenic shock (HR 1.188, p=0.1098), or cardiac arrest (HR 1.155, p=0.1979). Conclusions: In patients with previously diagnosed MR, a subsequent diagnosis of MAC was associated with increased 1-year risk of hospitalization, new onset ischemic heart disease or HFpEF, and a variety of other adverse cardiovascular outcomes.